Discharge & Billing
The way the hospital charges for inpatient services changed on 1 April 2009.
We have moved to an international standard called case-based reimbursement. This method of charging for services has been recommended by a number of recent independent reports on the hospital, including the recent Johns Hopkins Medicine International Review.
Case-based reimbursement – what does it mean?
Instead of charging one rate for every day you are in hospital, we charge fees based on your diagnosis. For example, if you have a hip replacement there is a charge for this diagnosis that will include tests, supplies and the length of time you would be expected to stay in hospital.
Three reasons why case-based reimbursement is a better way of charging
- It is a fairer and more transparent way to fees
A fee schedule based on someone’s diagnosis is a fairer, more transparent way to charge people for services used. It means someone who is admitted to hospital will be charged based on the type of treatment and services associated with their diagnosis. Previously, the hospital charged one daily rate, no matter how many services were needed.
- This way of charging helps improve the quality and efficiency of hospital care
This way of charging means the hospital is paid for a quality and efficient service. In other countries it has shown to help reduce length of stay, reduce unnecessary tests and standardise care.
- Charging fees based on internationally-recognised diagnoses makes us more accountable
As the fee structure is used elsewhere, we can compare our fees with US hospitals to ensure a fair rate is being charged.
Will this way of charging fees increase my healthcare costs?
This is a different way of charging and the move to this new system will not increase hospital revenues overall. Your individual healthcare costs will be based on your diagnosis – this means it could be more or less than the previous “per diem” rate. Over time, most countries find this method of charging helps control healthcare costs.
Johns Hopkins Medicine International report on the hospital summarises that a change to case-based reimbursement: can result in cost savings to the insurers and the government of Bermuda as the hospital becomes more efficient, plus better outcomes and shorter lengths of stay for patients and an overall improvement in health care efficiency for the people of Bermuda.
Why are insurers saying this is causing a rise in premiums?
We have been working with local insurers and Government for over a year to ease the transition as both insurers and Government cover hospital fees for certain client groups. Depending on what their clients come into hospital for will affect what premiums insurers and Government set – this could be higher or lower than previously. It should also be noted that the hospital makes up about half of Bermuda’s healthcare costs so there are other costs that impact premiums – such as people travelling overseas for medical care, use of other healthcare providers on island and, for private insurers, whatever profit margins they deem appropriate.
Overall, however, while fees go up each year due to inflation the costs to the healthcare system overall should not rise further because of this change.
If you have any questions about the new charges, or specifically with your bill, please contact the hospital’s Credit and Collections Office.